Innovative Opportunities for Pharmacists in the Evolving World of Healthcare

Transcription

1 Innovative Opportunities for Pharmacists in the Evolving World of Healthcare Christina Pornprasert, PharmD Population Health Clinical Pharmacist Hartford Healthcare Integrated Care Partners Assistant Clinical Professor University of Connecticut School of Pharmacy Addolorata Ciccone, PharmD, BCGP Geriatric Clinical Pharmacist Jefferson House, Hartford Healthcare Adjunct Assistant Professor University of Connecticut School of Pharmacy Senior Schwarting Symposium April 6, 2017 Faculty Disclosure Dr. Pornprasert has no actual or potential conflict of interest associated with this presentation Dr. Ciccone has no actual or potential conflict of interest associated with this presentation 2 1

2 Objectives 1. Identify trends in healthcare reform that require innovative pharmacy services across the care continuum 2. Describe development and implementation of clinical pharmacy projects and programs within an accountable care organization and a skilled nursing facility 3. Explain successes and barriers encountered while establishing new practices 3 Elderly represent about of our emergency medical services: a) 20% a) 40% b) 60% c) 80% 4 2

3 Future impact of an aging population Millions U.S. Census Bureau, 2015 Population Estimates and 2015 National Projections Projection of population 65 y/o in the United States Healthcare resources Elderly comprise 15% of population but represent: 38% of emergency medical services 35% of hospital stays 34% of prescriptions 26% of physician office visits American Geriatrics Society. Policy Priorities Jul. 3

4 Goals of Healthcare Reform: Triple Aim Institute for Healthcare Improvement, The Triple Aim 7 The Healthcare Paradigm Shift The Past: Reactive and Volume based The Future: Proactive and Value based FROM TO Traditional FFS Value-based Care Procedure-based Outcomes-based Fragmented Treating Sickness Integrated Preventing Sickness Healthcare Information and Management Systems Society (HIMSS) 4

5 MACRA Centers for Medicare & Medicaid 9 CMS Quality Payment Program MACRA MIPS Merit-based Incentive Payment System APMs Advanced Alternative Payment Models CMS = Centers for Medicare & Medicaid 10 5

6 Merit-based Incentive Payment System (MIPS) Overview 2017 Performance Year/ 2019 Payment Year 2018 Performance Year/ 2020 Payment Year 2019 Performance Year/ 2021 Payment Year 25% 15% 60% 0% Centers for Medicare & Medicaid 25% 25% 50% 15% 15% 10% Quality Cost Advancing care information Improvement activities 11 30% 30% Centers for Medicare & Medicaid 12 6

7 Which of the following regarding MACRA is FALSE? a) Stands for Medicare Access and CHIP Reauthorization Act of 2015 b) Establishes new ways to pay physicians for caring for Medicare beneficiaries c) Cost performance category will remain the lowest weighted category for the next 3 years d) Incorporates value-based care Centers for Medicare & Medicaid 13 University of Connecticut School of Pharmacy Unique Public Private Partnership Hartford Healthcare Integrated Care Partners 14 7

8 Identifying High Modifiable Medication Risk Patients 15 medications 2 documented falls High risk meds (BEERS Criteria) Opioid + Benzodiazepine in 65 y/o Complicated medications per case-manager Complicated hospital stay with ACS preventable comorbidity Documented cognitive impairment and living alone Poor adherence American Geriatrics Society Beers Criteria Falls in the Elderly, Am Fam Physician Apr 1;61(7) Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf Jan ACO Pharmacist Role in Patient Care RISK STRATIFICATION - SAS/Pinnacle - Nurse referral CASE REVIEW -Home Visit - Virtual MTM - Clinic Co-Visit CARE COORDINATION -Document interventions - Inform providers - Tag for follow-up PRN - Engage health coach ACO = Accountable Care Organization SAS = Statistical Analysis System MTM = medication therapy management Hartford HealthCare Integrated Care Partners 8

9 APRN at Home Pilot Referral from PCP, nurse, or hospital PharmD Med Review & Rec s Home visit by APRN +/- PharmD Transition to routine office visits within 90 days Hartford HealthCare Integrated Care Partners 17 ACO Pharmacist Role in Population Health Medication education and training for ACO staff Standardization of medication review and reconciliation Input/alignment into outpatient EMR order sets Provider education Feedback on pharmacy dashboards Developing pharmacy-related metrics and action plans Facilitate pharmacist roles in practice transformation EMR = electronic medical record J Manag Care Spec Pharm Apr; 21(4):

10 Asynchronous CME Videos for Providers CME = continuing medical education Hartford HealthCare Integrated Care Partners 19 Pillar Calls with Physician Leaders: Medication Initiatives Hartford HealthCare Integrated Care Partners 20 10

11 Step-by-Step Guide for Ordering Prescriptions Hartford HealthCare Integrated Care Partners 21 Innovative Grant-Funded Position - Embedded Geriatric Clinical Pharmacist (GCP) Jefferson House Cedar Mountain Commons SNF = skilled nursing facility STR = short term rehabilitation LTC = long term care ALF = assisted living facility 104-bed SNF STR LTC hospice Independent retirement ALF 11

12 2014 OIG report on adverse events in SNFs 1 in 3 SNF residents were harmed by an adverse event within 35 days of stay Nearly 60% of events were preventable 37% of events were related to high-risk medications Estimated hospital readmission costs $8,372 if medication-related $14,599 if infection/antibiotic related U.S. Department of Health and Human Services, Office of the Inspector General (2014). Adverse Events in Skilled Nursing Facilities: National Incidence among Medicare Beneficiaries (OEI ). Washington, DC. < Accessed November 13, According to the Medicare Payment Advisory Commission (MedPAC): a) Post-acute care (PAC) accounts for the highest spending growth in the U.S. b) Medicare per capita spending on PAC varies more than any other covered service c) SNFs should share the responsibility with hospitals for 30-day readmissions d) All of the above MedPAC Report to the Congress: Medicare Payment Policy. Medicare s post-acute care: trends and ways to rationalize payments. March medicare-s-post-acute-care-trends-and-ways-to-rationalize-payments-march-2015-report-.pdf?sfvrsn=0. Accessed November 13,

13 Embedded GCP Goals Expanding PAC Pharmacy Services Resolve medication-related problems (MRP) Reduce potentially inappropriate medication (PIM) use Reduce medication-related complications Reduce re-hospitalizations Facilitate care transitions Increase patient satisfaction Reduce medication-related cost GCP = Geriatric Clinical Pharmacist PAC = post-acute care Polypharmacy Risk factor for: MRPs Noncompliance Embedded GCP focus: Simplify medication regimen De-prescribe PIMs MRP = medication-related problem PIM = potentially inappropriate medications 13

14 Embedded GCP Clinical Role Medication reconciliation upon admission, readmission, and transition home Medication-related care coordination on transition home Real-time consults LTC comprehensive medication therapy review Communicate, document, and follow up on recommendations Attend team meetings and care conferences Prioritize high-risk medications and disease states According to a 2014 OIG report, the following medication classes are most commonly involved in ADEs in SNFs EXCEPT: a) Hypoglycemics b) Anticoagulants c) Opioids d) Antipsychotics U.S. Department of Health and Human Services, Office of the Inspector General (2014). Adverse Events in Skilled Nursing Facilities: National Incidence among Medicare Beneficiaries (OEI ). Washington, DC. < Accessed November 13,

15 Embedded GCP Educational Role Staff in-services In-house drug information resource Resident and family education programs Community outreach presentations Rotation site for students and residents Embedded GCP Administrative Role Eliminate redundant consulting pharmacy services Streamline medication-use system formulary, standard order set, med pass, storage Cost-containment initiatives Medication-safety initiatives Establish pharmacy dashboard QI goals Address pharmacy-related CMS quality measures Explore reimbursement opportunities 15

16 Embedded GCP Research Role Identify outcome measures Develop methodology and data analysis Create data collection tools Pursue scholarship opportunities Successes in New Practices Collaborative interdisciplinary relationships More efficient use of nursing time Track and share positive outcomes Gather patient success stories 16

17 Keys to Success Self-driven in a start-up setting Balancing multiple competing priorities in a fast-paced environment Self-assessment skills Passion for working with geriatric population Interpersonal communication skills Customer service Ability to work in a team environment Critical problem solving skills Barriers in New Practices Resistance to change Multiple competing priorities Technology limitations Delayed provider response Lack of cross-coverage 17

18 Overcoming Barriers Perform thorough ongoing needs assessment Assess local culture Appreciate separate realities Persistent efforts Consistent deliverables Flexible approach Prompt conflict resolution Ongoing communication Innovative Opportunities for Pharmacists in the Evolving World of Healthcare Christina Pornprasert, PharmD Population Health Clinical Pharmacist Hartford Healthcare Integrated Care Partners Assistant Clinical Professor University of Connecticut School of Pharmacy Addolorata Ciccone, PharmD, BCGP Geriatric Clinical Pharmacist Jefferson House, Hartford Healthcare Adjunct Assistant Professor University of Connecticut School of Pharmacy Senior Schwarting Symposium April 6,